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Wednesday, January 20. 2010

Going in to the 2010 November elections, should Congressional Republicans just be saying no to Democrats’ ObamaCare or offer their own program?

Reluctantly, as there are some constructive remedies in the Republican approaches, no is the correct answer.President Obama and Congressional Democrats in recklessly swinging their 2008 majority stick have blithely poked the hornets nest and are being chased by a popular uprising saying “no to Washington.”There’s no reason to help Obama or Democrats or to damage Republican prospects.

Hard-core proponents of ObamaCare say they’re already damaged politically, and would lose more liberal support if delaying, so they might as well charge ahead, and even unilaterally ram it through. As ABC reports, however, the public has spoken, “no.”

Congressional Democrats still have a large majority and will not accept a Republican program unless large elements of the Democrats’ is included.That would still move us down the road toward government control of individual choices, toward larger deficits and higher taxes. Most hard-core left Democrats have not and will not give up on getting their way.

Congressional Democrats and the liberal media would use a Republican alternative as an opportunity to shred Republicans as uncaring or not doing enough to meet their visions, and delusions, that there is a magic bullet that solves all real and purported problems.

Washington is still Washington, regardless of party, and lobbies would again kick into high gear to tilt to their own narrow advantage Republican proposals.Enough Republicans, like Democrat politicians, would be swayed, and Republicans as a whole would be tarred and Republicans’ most energetic base be turned off by smarmy politics as usual in Washington.

Medicare, Medicaid, SCHIP, Tricare, civil service employees and other government health spending already have constituencies of almost half the population.They will fight against almost any changes, especially benefit reductions or higher out-of-pocket costs or taxes, and many Republican leaners among them would turn away from Republicans.

If Republicans do get or get near a Congressional majority in November, there will be a better chance for enacting some strictly limited improvements. But, they must be highly focused and uniformly supported, without any addition of Democrat statism.Rather than being put forth as going for too much and all-or-nothing like the Democrats have theirs, the Republican proposals should be presented as reasonable incrementals that improve without financial excesses or intrusion into personal lives.That doesn’t mean that improvements will be minor but, rather, reasonable, respectful of individual needs, and limit government interference in free choices.

Here’s what would work, cumulatively helping the poor, the middle-class, and the more affluent, enlarging care for all without taking away deserved care.

1. Allow individual tax-deductions for premiums. Individuals who don’t get that deduction currently would be encouraged to obtain health insurance.The poorer would be no worse or better off.The middle-class uninsured would be on equal terms to those receiving employer-paid benefits.

2.Broaden IRS Section 125 to allow individuals to use pre-tax income for health careexpenses.Eliminate the current “use-it-or-lose-it” provision so such savings can accumulate toward catastrophic needs, Part D Medicare Rx “donut-hole” expenses, professional long-term care for loss of two or more of the currently defined “activities of daily living”, or other IRS Section 213 (the Section that lists allowed professional medical treatments) retirement medical care. Section 213 would be broadened to include Over-The-Counter medications, if prescribed by a doctor or dentist.Again, the middle-class would be benefitted who aren’t employed and provided Section 125 plans or employed and not offered employer Section 125 plans.Current health savings accounts, HRA’s and HAS’s, would remain the same, and be immediately vested if funded.

3. Retain Medicare Advantage programs, which have higher benefits and lower co-paysthan straight Medicare, and are more widely used by the poorer, but limit those higher benefits and lower co-pays to medical, dental and vision care, dental care not currently provided.This would allow some reduction in government subsidies.Other ancillary non-core benefits would be eliminated, so broader need core benefits would be provided.Medicare Advantage plans use networks with negotiated rates and some gatekeeper-usage controls, which reduces their costs and, as presently, would have to compete with each other.

4. Require full portability of individual medical insurance to other carriers at the same or lower actuarial level of benefits, reducing loss of coverage when moving to another area and increasing competitive measuring across carriers that reduces confusion.Rather than guarantee issue incenting individuals to wait until after they’re sick or injured, driving up the premiums of the more responsible, individuals would have more incentive to at least lock-in more affordable and more catastrophic benefits.

5. Allow insurers to offer their plans nationally, to increase choices of benefit levels.Of course, premiums in each area would reflect local costs.This would, also, increase measurement and knowledge of local variations in costs on an apples-to-apples basis, and competitive pressures reduce higher outliers.

6. Allow all immigrants, whether legal or illegal, to enroll in private or government health plans but require full payment of full-cost premiums.This would reduce their uninsurance among the more more responsible and those able to afford premiums.Legal immigrants would be required to provide proof of insurance, whether private or governmental, and could not be naturalized to citizenship unless providing proof of “credible” medical insurance (“credible” as per the current HIPAA law) from the date of entry to the US.

7. Provide means-testing (includes income and all financial assets up to, say, medical expenses of 10% of their combined total) of uninsured citizens and legal immigrants who obtain professional health or dental care, possibly professional long-term care (as discussed above) in order to apply for government assistance. The government assistance would be for the cost in excess of that 10% per year that is above the same rates as the provider’s highest rates negotiated with a private insurer + 20%. Currently, “list” prices charged those uninsured may be 30-100% higher than negotiated with insurers.This would protect the poor while incenting obtaining coverage, at least cheaper catastrophic coverage.Those qualified uninsured would be required to enroll in the appropriate government program.

8. Require tort medical cases to be heard by specialized courts, to reduce the sway of emotions in outsize judgments.Tort attorneys would receive fees up to 30% of pre-negotiated settlements, but 25% of trial judgments, encouraging more reasonable and less legally costly results for those who deserve recompence.

9. State Medicaid or SCHIP programs offering benefits above the federal level of benefits or enrollee income would be ineligible for any federal subsidies. Higher “welfare” states would not be able to pass their largesse on to taxpayers elsewhere, and would have to justify them to their own voters.

10. Private or government retiree health programs would be required to become fully actuarially funded within 5-years, or face loss of tax-reduction in the case of private plans or be required to reduce of benefits in the case of government plans.This would include previously negotiated union plans.

The Democrats’ vision of the “perfect” is the enemy of the “good.”There is little public support for the Democrats’ overexpansive, excess cost, intrusion into our very lives.There is widespread support for the above reasonable improvements.

Republican Caginess Drives Dems Nutty
The Hill, chronicler of doings in the US Capital, left a word out of its report that the “Senate bill to repeal health reform lacks backing from GOP leaders”, the missing word being “yet.” The report makes clear that the GOP leadership “support repealing

Weblog: Maggie's FarmTracked: Jul 05, 22:53

Republican Healthy Caginess Drives Dems Nutty
The Hill, chronicler of doings in the US Capital, left a word out of its report that the “Senate bill to repeal health reform lacks backing from GOP leaders”, the missing word being “yet.” The report makes clear that the GOP leadership “support repealing

Nah I'm independent, I just think that none of these options were included in the Dems' bill. I'm very much to the left, much farther than the Senate Dems are willing to go. They are too much in the pockets of the insurance companies.

I think if we can't pass single payer, or Veteran Care For All, then we must offer public option, ban on PECs, and ban on coverage caps.

I feel that many people who do not have healthcare are left out of the Dems' bill because it is trying to do too much at once and thus has to compromise on everything.

I believe Jesus would want all to be covered, no matter the cost. I keep talking to my pastor at church about this, he tells me that if we can pay for war, we can pay for healthcare.

Howdy, jarjar
As a committed Christian, how about you put your hand into your own pocket for charity, and for your own responsibilities? And I'll keep my hand out of your pocket. Your position, well left of mine obviously, is anti-freedom and it makes generosity a demand, not a gift.

Tort attorneys would receive fees up to 30% of pre-negotiated settlements, but 25% of trial judgments, encouraging more reasonable and less legally costly results for those who deserve recompence.

Sorry, I don't understand this one, if health care should be free, why not legal representation?

2% for pre-negotiated settlements and 1% for trial judgements. Let's take the profit motive out of the tort system.
An additional clause should be that all lawyers must represent any person, regardless of their ability to pay. Lawyers would then be on equal footing with the doctors they so despise.

Our current health insurance situation is forced on us because Americans didn't pay attention to what our legislators did over the last 50 years. Medicare/Medicaid is the big dog and we allowed it to be the controlling force. For example, doctors who see Medicare patients must charge the same cost for the same procedure to patients who pay cash or are enrolled in a different insurance plan that would allow a lower cost. In the same manner, HMO rules force patients into higher costs and expose doctors to more liability. Medicare forces higher costs for COBRA coverage after retirement or in situations where the individual doesn't fit in his previous plan.

Any real consideration to reform health care must start at the very foundation and must not just change what we have by just adjusting a few of the rules to allow for our favorite procedure or practice.

This change will never happen because too many people in Washington and along the way want to fill their wallets with the easily pilfered cash involved in health care. One example of that pilfering is health care billing. In the mid 1990s there were work-at-home individuals contracting with specific doctors to transcribe patient records for that doctor and to fill out the billing forms properly so that payment would be quick and error free. The large hospitals and HMOs took that process to the Federal Courts with the statement that people working at home could not keep those records secure and that they could not be trusted with those records. The Circuit Court agreed and forced the record keeping to be maintained with much higher costs. Security was not the issue. Who got the money was the issue.

That was one small example of the fleecing of American health care. It happens at all levels and in all portions of the industry.

Medicare/Medicaid, our HMOs and other insurance plans are only doing what Congress told them to do. This is why we have the health oligopolies that cost us dearly even when we maintain our health and don't see the doctor. The foundation needs to be fixed first.

Ugh, this is just bad. Bad, bad, bad. Republicans are hurting among us conservatives because they have their head up their asses. This is not a reform, this is a freaking band-aid.

Insurance premiums are through the roof due to OVER CONSUMPTION, not anything else.

1. End federal tax subsidies to employers.
2. Make Medicare optional.
3. End federal Medicaid subsidies, if the state want to insure everyone - they can go ahead and watch their state budgets explode. Oh wait...
4. Get the FDA out of regulating pharma companies, they do nothing but make drugs insanely expensive.
5. Remove anti-trust exemptions
6. Remove federal regulations, obviously allow inter-state commerce.
7. Cap malpractice
8. End the federal ban on organ donor harvesting from cadavers.
9. Repeal HMO act of 1973

In time this will dramatically reduce costs of all medical services, make insurance affordable and more competitive. Innovation will further expedite cheaper prices as donor operations, drugs and creative disaster coverage insurance plans flood the market.

THIS IS REFORM. It is not appealing to those entitled, hard to implement, hard to sell and the only thing that can save this country. Everything else is junk.

If the FDA doesn't regulate drug companies...someone will have to. And they'll need to be EVEN TOUGHER than the FDA.
Drug companies aggressively market many drugs that haven't been adequately tested. And many drugs have often benn pulled from the market because they've been tested by the FDA and found to have deadly side affects:

Rezulin: Given fast-track approval by the Food and Drug Administration (FDA), Rezulin was linked to 63 confirmed deaths and probably hundreds more. "We have real trouble," a Food and Drug Administration (FDA) physician wrote in 1997, just a few months after Rezulin's approval. The drug wasn't taken off the market until 2000.

Lotronex: Against concerns of one of its own officers, the Food and Drug Administration (FDA) approved Lotronex in February 2000. By the time it was withdrawn 9 months later, the Food and Drug Administration (FDA) had received reports of 93 hospitalizations, multiple emergency bowel surgeries, and 5 deaths.

Propulsid: A top-selling drug for many years, this drug was linked to hundreds of cases of heart arrhythmias and over 100 deaths.

Redux: Taken by millions of people for weight loss after its approval in April 1996, Redux was soon linked to heart valve damage and a disabling, often lethal pulmonary disorder. Taken off the market in September 1997.

Pondimin: A component of Fen-Phen, the diet fad drug. Approved in 1973, Pondimin's link to heart valve damage and a lethal pulmonary disorder wasn't recognized until shortly before its withdrawal in 1997.

Duract: This painkiller was taken off the market when it was linked to severe, sometimes fatal liver failure.

Seldane: America's and the world's top-selling antihistamine for a decade, it took the Food and Drug Administration (FDA) 5 years to recognize that Seldane was causing cardiac arrhythmias, blackouts, hospitalizations, and deaths, and another 8 years to take it off the market.

Hismanal: Approved in 1988 and soon known to cause cardiac arrhythmias, the drug was finally taken off the market in 1999.

Posicor: Used to treat hypertension, the drug was linked to life-threatening drug interactions and more than 100 deaths.

Raxar: Linked to cardiac toxicities and deaths.

Testing drugs for safety is an expensive procedure.
I don't think anyone but the government has the resources and the ability to stand up to drug lobby.

It's nice to say "regulation only adds to the cost"..but there is always a price for safety. And without regulation drug companies would continue to keep dangerous drugs on the market even when their own testing shows that it has problems.

Drug companies cannot be trusted to self regulate. Too much money is invested in drugs and too much profit is made from them. As always Corporate Profits generally trump safety.

Every time a drug is pulled from the market, you can give thanks to regulation.
I think regulators should be more aggressive. Not a year goes by that some drug that people have been taking for years is found to be dangerously unsafe. At least the FDA is better than allowing the drug companies to decide which of their own drugs are unsafe and should be pulled from the shelves.

What a convoluted mess you suggest. It's no better than what is now on the table. Only one thing will work and that is single-payer, universal, non-profit health care. Insurance companies are the reason the costs are out of sight. They are parasites. We don't need health insurance, we need health care. There are four models that are currently in use in the industrialized countries. Read T. R. Reid's book The Healing of America.

I listened to Reid on Fresh Air and as soon as he said that Medicare, Tribal Medicine and the VA were the most popular HC delivery systems in the USA, I knew he was a shill. In the Dakotas, politicians run against single-payer by comparing it to "Reservation Medicine". Everyone knows what that is and wants nothing to do with it. At the VA, long waits and bureaucracy are the norm and doctors do not want Medicare. Reid's entire premise was that we take profit out of healthcare. How do you intend to get innovation or quality at that point? And note that we have healthcare in this country. I went to the doctor this week. It exists. It worked great. I, along with about 80% of us, am quite happy with my care. Unlike my Canadian friend who waited 9 weeks for an MRI and 13 months for surgery on a torn ACL. That is a long time on poain meds and a cane.

As usual, folks have thought about limiting plaintiff's attorney fees, but don't mention how much defense lawyers can get. Defense lawyers can charge hundreds of dollars an hour, assign more than one attorney to each task, and generally pile on the billable hours. They file massive documents of questions (interrogatories and requests for admissions) that they have preloaded on their computers that require days and days for the plaintiff to answer. The actions of large defense firms add at least as much to costs as plaintiff's attorneys.

Plus, if the plaintiff's attorney is limited in fee, the defense firms will engage in even more of this behavior - all in order to make representing plaintiffs financially unappealing. The result will be that truly injured people will not be compensated, and a large number of them will end up on welfare of one kind or another.

You make a good point, Juan.
I've started to think about this but haven't come to an answer yet, as defense attornies don't work on commission-fee as do plaintiff. Indeed, many work on fixed retainer, or for negotiated fees. Perhaps adding a "penalty" to the defense attorney (not the defendant) would help.
Thanks for commenting

Do it incrementally. Debate and vote on each proposal and enact it separately as law. Test it and if it doesn't work change or repeal it. Move on to the next point. No need to do "comprehensive" reform. Comprehensive creates too large and complex a bill with too many areas of conflict, unintended consequences and screw ups...not to mention places to hide deals and pork.
Also, consider doing away with Medicare and issuing vouchers for individuals to purchase their own insurance. Get Government out of the healthcare insurance business completely...except possibly to moderate high risk pools for preexisting conditions coverage. Government doesn't do anything efficiently - look at the estimated (by the Government) $80 BILLION a year in Medicare/Medicaid fraud!!

Paragraph internet articles captured and merged into the power of a single thought that could tell a story. AmeriChoice Launches National Support Initiative for Community . Joins initiatives in more than 300 locations nationwide to recognize and support the work of Community Health Centers to provide health care to the ...
AmeriChoice of New Jersey is sponsoring or participating in 22 events at community health centers, in support of National Health Center Week, August 9-15, led by the National Association of Community Health Centers (NACHC). “As a partner with the New Jersey Department of Human Services in Medicaid, Personal Care Plus and NJ Family Care, we are committed to improving access to quality, affordable health care for the most vulnerable populations in America,” said John Kirchner, AmeriChoice of New Jersey president. Community Health Centers serve 18 million people at more than 7,000 sites nationwide, providing quality health care, supported by AmeriChoice corporate parent, UnitedHealth Group. About AmeriChoice of New Jersey, AmeriChoice of New Jersey serves approx. 275,610 Medicaid and NJ Familycare members in the state. The health plan is a unit of AmeriChoice, the public sector health care business of UnitedHealth Group (NYSE: UNH). UnitedHealth Group is a diversified Fortune 50 health and well-being company. AmeriChoice serves 2.6 million people in more than 20 states and the District of Columbia. CEO of AmeriChoice Health Bolts. John J. Kirchner - Director, Operations John Kirchner joined Healthfirst in May 2010 with over 25 years experience in health care management. Mr. Kirchner’s background includes responsibility for health plan P&L, strategic planning and operations, and government and regulatory affairs. Mr. Kirchner will be responsible for supporting all aspects of NJ health plan operations. Prior to joining Healthfirst, Mr. Kirchner held a variety of positions at AmeriChoice of New Jersey serving as President from 2007 through 2009. Judical decision, It’s true there is email thanking AmeriChoice health for their $25,000 cash gift and requesting much larger amounts for the pending year etc. from Community Health Center located in Bridgeton N.J.etc. It’s also true a licensed Health agents was fired for his refusal to deliver these checks. It’s true this behavior violates all the laws concerning bribes, kickbacks,fraud and Stark laws. It’s true this taint’s all the business then received from Community health center to AmeriChoice Health Company and then submitted to Mediciad and should be then held accountable and subject to all violations. Among its provisions, the anti-kickback statute penalizes anyone who knowingly and willfully solicits, receives, offers or pays remuneration in cash or in kind to induce, or in return for: A. Referring an individual to a person for the furnishing, or arranging for the furnishing, of any item or service payable under the Medicare or Medicaid program; or B. Purchasing, leasing or ordering , or arranging for or recommending purchasing, leasing or ordering, any goods, facility, service or item payable under the Medicare or Medicaid program. Violators are subject to criminal penalties, or exclusion from participation in the Medicare and Medicaid programs, or both. A violation of the anti-kickback law is a felony offense that carries criminal fines of up to $25,000 per violation, imprisonment for up to five years and exclusion from government health care programs. The federal anti-kickback statute, 42 U.S.C.§ 1320a-7b(b), prohibits individuals or entities from knowingly and willfully offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid or any other federally funded program. For purposes of the anti-kickback statute,remuneration means or includes the transfer of anything of value, directly or indirectly, overtly or covertly, in cash or in-kind. ps Wonder how many other cash checks were disbursed to community centers by AmeriChoice Health guess only the Shadow knows the DOJ certainly does not. Don't you just love the words partner, collaborate, team player and yes, these words should be made trigger words for someone or something getting screwed.

Election Year Medicaid Medicare Inducement issues left open for November not openly discussed.Politics have gone from heated to man on fire thoughts. Also the Judicial dilemmas, since all are offically allowed to bear arms again, the big city Mayors are concerned about how the poor will be able to rearm themselves, and are looking for some type of financial relief from Federal State Medicaid programs to maintain their status quo.The higher courts face tough issues this term since making honest fraud legal, there agenda now turns toward making honest kickbacks and honest bribes equally as legal. This topic remains high as a shared issue by the medicaid medicare enrollment providers since they are looking to expand inducements past the complicated pregnancy stage.The DOJ has serious concerns that if legalized marijuana in California for medical reasons could be used as a inducement or inticement to help secure new enrollments for the Federal State Medicare Medicaid programs.The State of California is concerned that if the Feds step up their effort in killing off the marijuana crops it could cause higher tax problems that effect Medicaid currently under consideration by the State 'marijuana tax control board'. Limo drivers cancel their planned Medicaid Cuts DC rally and leave for California to protect this years crop. Wow, don't think I would like to be in Politics for this years elections. Govenor Schwarzenegger indicated that if the Tea Partys membership keeps holding their rallies at our Marijuana burning fields they will have to be taxed for their free use of inhalants, prior to having them bused back to Arizona.

The best solution to America's health care problem is for insurance companies to offer big discounts to patients who seek treatment overseas.
Countries like India, Thailand, Malaysia, Singapore and Korea have set up hospitals that meet or exceed American standards and offer the same treatment at 1/3 to 1/10 the cost .
American medicine is outrageously expensive. It won't be brought down unless all the participants...insurance companies, doctors, hospitals and lawyers are willing to take a cut.
But everyone is fiercely protecting their interests and feel they have the American consumer by the "b-lls". No competition.
I've been using the services of Thai doctors,hospitals and dental clinics for over 5 years now.
Even after airfare to Bangkok I save a lot of money and get more thorough treatment.
For example, a heart bypass operation that might cost 100,000 dollars in the US runs about 20,000 in a Thai hospital.
2 years ago I had minor surgery on my throat. a 2500 dollar procedure that my US doctor would have performed in his office cost me only 100 dollars in a Thai HOSPITAL.
I do all my dental work in Thailand now (except for the infected abscess I had to have taken care of here in the US.)
And don't think that Thai hospitals are some dungeon of horror. Thai private hospitals are run like 5 star hotels with the latest equipment and service that beats any hospital that I've been to in the States.
We could cut our health care cost in half if we could access foreign hospitals.
But insurance companies are slow to allow people discounts for using cheaper foreign hospitals.

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